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PubMed1989

A longitudinal survey of self-reported bowel habits in the United States.

Information concerning bowel habits was gathered from a representative sample of 14,407 United States adults in the first National Health and Nutrition Examination Survey in 1971-1975 and approximately 10 years later among the same individuals. The prevalence of self-reported constipation, diarrhea, infrequent defecation (three or fewer bowel movements per week), and frequent defecation (two or more bowel movements per day) increased with aging. Women were more likely than men (P less than 0.05) to report constipation (20.8% compared to 8.0%) and infrequent defecation (9.1% compared to 3.2%). Blacks were more likely than whites to report infrequent defecation (P less than 0.05). Older respondents reporting constipation were more likely to use laxatives or stool softeners than younger respondents reporting constipation, but they were also less likely to have infrequent defecation. To evaluate factors predictive of impaired bowel function, case definitions were created using information concerning complaint of constipation, laxative use, frequency of defecation, and stool consistency. Female gender, black race, fewer years of education, low physical activity, and symptoms of depression were independent risk factors for impaired bowel function. This study provides national estimates of bowel complaints and their natural history and examines possible risk factors for constipation.

Adult↗
PubMed1978

[Preoperative preparation in colorectal surgery: antibiotics (author's transl)].

Out of a total of 2727 operations of the large bowel because of tumors and inflammatory disease, performed over a 14-year period, 897 were one-stage resections of the colon and rectum without relaxing colostomy. Standard preoperative preparation of the bowel consists of a balanced diet, laxatives, and enema supplemented by 9 g Neomycin and 1.8 g Achromycin, within a 2-day period. Disturbances in wound healing occurred in 12.5%, seroma included. Anastomotic insufficiency occurred in 4%, and fatal fecal peritonitis due to tumors in 1.3% and due to diverticulitis in 1.2%. Total mortality was about 5.7%. Postoperative hospitalization after resections because of tumors was 15 days and because of diverticulitis, 19 days.

Cathartics↗
PubMed1988

A randomised trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids.

In a prospective randomised trial, 43 patients with bleeding haemorrhoids were allocated to receive either a bulk laxative with injection of phenol (5%) in arachis oil (20 patients) (Group 1), or a bulk laxative alone (23 patients) (Group 2). Treatment was given by one author and patients were assessed "blind" by the other at 6 weeks, 3 months and finally at 6 months. At 6 weeks 12 (48%) in Group 1 and 12 (57%) in Group 2 were still bleeding (NS; chi 2 = 0.54). At 3 months 10 (40%) in group 1 and 6 (35%) in group 2 (NS; chi 2 = 0.10), and at 6 months 10 (43%) in group 1 and 7 (47%) in group 2 were still bleeding (NS; chi 2 = 0.04). No significant difference in bleeding at 6 months after either injection sclerotherapy with bulk laxative or bulk laxatives alone was found.

Adult↗
PubMed1968

[Hypokalemia].

Explore the source record for details and available documents.

Adolescent↗
PubMed1987

[Secondary gout and pseudo-Bartter syndrome in females with laxative abuse].

Four females (27-54 y), presenting with a history of long-term laxative abuse, were admitted to the Medizinische Poliklinik for evaluation of generalized weakness. Laboratory findings revealed signs of Bartter's syndrome, including hypokalemia, systemic alkalosis and normal blood pressure. Three of the four females showed impaired renal function and elevated serum uric acid levels, two of them suffered from recurrent gouty attacks. In our patients the incidence of hyperuricemia and impaired renal function, as a consequence of chronic hypokalemia, was much higher than known from patients with Bartter's syndrome. Hyperuricemia is related to some pathophysiological features of Pseudo-Bartter's syndrome, (e.g. systemic alkalosis, elevated angiotensin) and combined with additional factors (e.g. catabolism, reduced plasma volume) may lead to gouty attacks. Gallstones were found in two of the four females. Long term surreptitious laxative ingestion frequently is observed in females. Hypokalemia, induced by the laxatives, causes reduced intestinal motility and leads to augmented laxative intake. These patients are prone to develop Pseudo-Bartter's syndrome, causing eventually a hyperuricemia and gouty attacks.

Adult↗
PubMed1982

Colon cleansing regimens. A clinical study in 1200 patients.

The purgative effect of bisacodyl, anthraquinone glycosides (Cascara), and sodium picosulfate, alone or in combination with a saline purge and a tap water enema, was studied in 1200 patients. The cleansing effect was scored with regard to retained fecal residue evident on double-contrast studies of the colon. The combination of a contact laxative and a saline purge produced good cleansing effect in 52%-80% of the patients. With an additional tap water enema given 1 hour before the colon examination, however, 96% of the colons were clean. The taste and the effects of the cleansing systems were tolerated favorably by more than 90% of the patients. However, 17% reported restriction in work capacity on the day of bowel cleansing.

Adult↗
PubMed1990

Laxatives prior to small bowel follow-through: are they necessary for a rapid and good-quality examination?

Fifty-six patients undergoing small bowel follow-through examination were randomly allocated to two groups to assess the effect of preparation with laxative on the speed and quality of the examination. We found that laxative had no effect on either speed of the examination or quality of visualization of small bowel. However, the latter was dependent on the degree of supervision and technique of the examining radiologist.

Barium Sulfate↗
PubMed1978

Is the effect of diphenolic laxatives mediated via release of prostaglandin E?

The diphenolic laxatives, bisacodyl and phenolphthalein, and the osmotic laxative mannitol increase intestinal fluid volume in the rat colon in situ. The diphenolic laxatives stimulate the biosynthesis of prostaglandin E (PGE) whereas mannitol does not. Inhibition of PG-biosynthesis by pretreatment with indomethacin only reduces the effect of the diphenolic laxatives. It is suggested that diphenolic laxatives increase intestinal fluid volume via stimulation of PGE biosynthesis in the colon.

Animals↗
PubMed1981

Lasting effects of acute dehydration and post-weaning undernourishment on cortical spreading depression in adult rats.

Acute dehydration (D) early in life made adult rats less susceptible to cortical spreading depression (SD) than control (C) rats. Post weaning undernourished (U) rats tended to be more susceptible than controls. The association of D and U (DU group) made rats more susceptible to SD than U-rats. It is suggested that this association gives rise to a more complex pathological state than that which would result from the summation of the effects of its components.

Animals↗
PubMed1995

Stimulated gracilis neosphincter--not as good as previously thought. Report of four cases.

PURPOSE: We report the outcome of four patients who had stimulated gracilis neosphincter for fecal incontinence to highlight functional problems, particularly in patients with impaired rectal evacuation. METHODS: The gracilis neosphincter operation consisted of a three-stage procedure in four patients with intractable incontinence, three of whom had had a pelvic floor repair. RESULTS: Despite successful muscle transposition and nerve stimulation, only one of four patients has a functioning neosphincter. One patient could not tolerate stimulation, and two were unable to evacuate the rectum. All three now have stomas, and even the functioning neosphincter patient requires regular bisacodyl (Dulcolax; CIBA Consumer Pharmaceuticals, Woodbridge, NJ) suppositories to achieve evacuation. CONCLUSION: The neosphincter is a successful sphincter but has no role for patients who cannot evacuate from the rectum.

Administration, Rectal↗
PubMed1997

Improvements in mechanical bowel preparation for elective colorectal surgery.

PURPOSE: This study was undertaken to determine whether a mechanical bowel preparation with 2 liters of polyethylene glycol solution combined with a laxative (Group A) increases the acceptability of bowel preparation and reduces discomfort compared with 4 liters of polyethylene glycol solution (Group B). METHODS: One hundred patients undergoing an elective colorectal resection were included in a prospective, randomized study. Acceptability (nausea, vomiting, abdominal cramps, discomfort from insertion of the nasogastric tube, and anal discomfort) was assessed using visual analog scales. Efficacy of bowel lavage was scored intraoperatively by a blinded surgeon. RESULTS: Overall acceptability was 5.1 +/- 2.8 in Group A patients and 5.6 +/- 2.6 in Group B patients (P = 0.5). The incidence and visual analog score for nausea, vomiting, anal discomfort, and cramps were not different between groups. Excellent efficacy of bowel preparation was shown in 94 percent of patients in Group A and 84 percent of patients in Group B (P = 0.5). The incidence of septic complications was 2 percent in Group A patients and 12 percent in Group B patients (P = 0.06). CONCLUSION: Because the acceptability of both cleansing regimens were not different, 2 liters of polyethylene glycol plus Prepacol should be preferred because the amount of fluid administered to clean the bowel is reduced and the nasogastric tube can always be avoided.

Aged↗
PubMed1997

Rectal prolapse associated with bulimia nervosa: report of seven cases.

PURPOSE: Rectal prolapse is a condition in which, when complete, the full thickness of the rectal wall protrudes through the anus. Bulimia nervosa is an eating disorder characterized by periodic food binges, which are followed by purging. Purging usually takes the form of self-induced vomiting, laxative abuse, and/or diuretic abuse. We report seven cases of rectal prolapse associated with bulimia nervosa. METHODS: The case histories of seven women with rectal prolapse and bulimia nervosa, average age 29 (range 21-42) years, seen over a period of 11 years (1987-1997) were reviewed. An analysis of the clinical data, including history, presenting physical examination, surgical treatment, and outcome was performed. RESULTS: All seven patients had a diagnosis of bulimia nervosa, made either before or with a diagnosis of rectal prolapse. Rectal prolapse was confirmed in each patient at anorectal examination. Five patients underwent sigmoid resection with proctopexy, one died before operative therapy, and one awaits further treatment. One of the five surgical patients had a recurrence that was managed by a perineal rectosigmoidectomy. CONCLUSION: To our knowledge, despite extensive review of both bulimia nervosa and rectal prolapse as seen in the medical literature, an association between the two has not been described previously. Several aspects of bulimia nervosa, including constipation, laxative use, overzealous exercise, and increased intra-abdominal pressure from forced vomiting are likely causes for the probable relationship with rectal prolapse. The possibility that an atypically young female presenting with rectal prolapse may also have bulimia nervosa should be taken into account by clinicians. This may assist the diagnosis of bulimia nervosa, a disease with multiple morbidities. Conversely, a patient being treated for bulimia nervosa who develops anorectal symptoms may come to earlier diagnosis and treatment for rectal prolapse.

Adolescent↗
PubMed1997

Cleansing ability and tolerance of three bowel preparations for colonoscopy.

PURPOSE: This study was undertaken to determine whether different regimens using sodium phosphate (NaPh) solutions resulted in better bowel cleansing than polyethylene glycol-salt (PEG) solutions and, if so, why. Side-effects and patient acceptability of the different regimens were also investigated. METHODS: A total of 486 patients requiring colonoscopy were randomly assigned to one of three preparations in a single-blind prospective study. The preparations were as follows: Group A, 3 liters of PEG solution taken at 2 p.m. the day before examination; Group B, 45 ml of NaPh solutions taken at 7 a.m. and 7 p.m. the day before examination; or Group C, 45 ml of NaPh taken at 6 p.m. the day before and at 6 a.m. on the morning of, examination. Cleanliness of the bowel was assessed blindly, and patients were questioned about side-effects and preferences for NaPh vs. PEG. RESULTS: Numbers, ages, and gender distribution of patients in the three groups did not differ significantly from each other. Cleanliness scores for the three groups were 3.34 +/- 0.97, 3.22 +/- 0.85, and 4.11 +/- 0.67 (Group C vs. Groups A and B, P < 0.0005; Group A vs. Group B, P > 0.30). Predominance of material in the right side of the colon was found in 13.7, 29.8, and 4.2 percent of Groups A, B, and C, respectively. In the three groups, nausea alone occurred in 3.8, 13.7, and 16.3 percent of patients; vomiting occurred in 0.6, 7.4, and 5.4 percent of patients; and dryness/thirst occurred in 1.9, 17.4, and 20.4 percent of patients, respectively. A total of 80.6 and 82.6 percent of those in Groups B and C who had previously had PEG expressed a preference for taking NaPh (P < 0.001). CONCLUSIONS: The regimen of Group C is significantly better than the regimens of Groups A or B in bowel cleansing. Regimens of Groups A and B did not differ in efficacy of cleansing. It is the timing of taking NaPh in the regimen of Group C rather than its composition that is responsible for its superior cleansing ability compared with PEG. Overnight deposition of small intestinal material in the right colon is partly responsible for the inferior cleansing ability of regimens that involve taking the solution on the day before colonoscopy. Despite a higher incidence of minor side-effects from NaPh than from PEG, a significantly higher proportion of patients preferred NaPh.

Aged↗
PubMed1990

Quantitative appraisal of Picolax (sodium picosulfate/magnesium citrate) in the preparation of the large bowel for elective surgery.

The authors have investigated the metabolic sequelae Picolax bowel preparation in a group receiving their preparation either 24 hours (n = 17) or 48 hours (n = 18) before elective colonic resection. No significant changes in any metabolic parameter were found in the 24-hour group. In the 48-hour group, there was a significant decrease in serum sodium (P less than 0.005), serum chloride (P less than 0.005), pH (P less than 0.005), HCO3 (P less than 0.005), and base excess (P less than 0.005). Only 16 of 35 cases (46 percent) had an acceptable bowel preparation: 11 of 17 (65 percent) in the 24-hour group and 5 of 18 (28 percent) in the 48-hour group. Marker studies did not correlate with the quality of bowel preparation. The risk of potentially explosive intraluminal gas was increased if the bowel preparation was poor: 12 of 19 patients (63 percent) with a poor bowel preparation compared with 3 of 16 patients (19 percent) of those with an acceptable preparation (P less than 0.005). Picolax is a poor mechanical bowel preparation and is associated with unacceptable physiologic disturbance if given two days before surgery.

Acid-Base Equilibrium↗